Healthcare Provider Details

I. General information

NPI: 1033646245
Provider Name (Legal Business Name): ABSOLUTE PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 SE I ST STE 5
BENTONVILLE AR
72712-0078
US

IV. Provider business mailing address

2713 SE I ST STE 5
BENTONVILLE AR
72712-0078
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-4355
  • Fax: 479-553-7954
Mailing address:
  • Phone: 479-250-4355
  • Fax: 479-553-7954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number711
License Number StateAR

VIII. Authorized Official

Name: MS. TICIA JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-250-4355